Tessier No. 4 facial clefts are one of the most challenging craniofacial anomalies to repair, and more complex than other craniofacial clefts. The common clinical features in Tessier No. 4 clefts consists of cleft lips which cross superiorly up to the lower eyelid, and decreased distance between the lips and lower eyelids due to displacements of the lower eyelids, and these findings are attributed to combined soft and hard tissue deficiency. Although surgeries for these patients should be planned after confirming of the patients’ physiologic conditions, the surgery should be performed as soon as possible in case of eyeball exposure. There are some surgical techniques to reconstruct Tessier No. 4 facial clefts, but the gold standard of surgical repair does not exist. We present a case of Tessier No. 4 clefts, using the Tessier technique including multiple z-plasty and glabeallar flap. In this case report, authors introduce the Tessier technique for the recontruction of Tessier No.4 facial cleft with literature review.